Volunteer ambulance service faster than state-run service but law puts it under threat — UCT study

Volunteer emergency services are sustainable and can go a long way in relieving pressure from mainstream emergency services and saving lives.

This is according to University of Cape Town researchers after new data shows that a community-run ambulance service in Hout Bay, Cape Town, responded much faster than the government-run emergency medical service (EMS).

The Hout Bay Volunteer Emergency Medical Service (HBVEMS) managed to save lives by meeting a target of arriving on the scene within 15 minutes for life-threatening calls.

Responding within their own community where they are familiar with roads led to about 42% faster response than the EMS, which often responds outside the area and has to navigate traffic before reaching patients.

Researchers argue tacit knowledge of roads in that community, especially in Imizamo Yethu and Hangberg, where there is informal housing and difficult-to-access roads, played a role in faster response times.

The five-year study, which analysed response times between 2015 and 2020 found the volunteer-run service, which mostly operates after hours when the volunteers are free from their daily careers “alleviated pressure on the EMS by freeing up resources (allowing) ambulances to respond to other incidents”.

Lead researcher Dr Charmaine Cunningham and her colleagues said there was a growing need for emergency medical care and volunteer ambulance services can have a meaningful effect on the continent.

“The findings support the benefit of developing community-based ambulance services, especially in areas that are remote due to distance or topography.

“The model can be expanded to other communities across the continent. A key factor for success is actively managing stakeholder relationships which include community-based relationships as well as governmental or formal emergency medical services relationships,” she said.

Started in 1994 by a group of residents that were concerned with the response times to medical emergencies in Hout Bay, the medical service was the oldest volunteer ambulance service in Cape Town.

Despite the short distance to 24 hours emergency medical facilities and formal EMS bases, responses were and still are delayed due to the mountainous topography.

Access and egress into Hout Bay are restricted to three two-lane roads via the mountains. This causes delays in medical emergency response times which is further hindered during times of high traffic flow.

“It was argued that developing a community response system in Hout Bay would result in shorter response times and consequently improved patient outcomes,” Cunningham said.

Between 2015 and 2020, researchers found that the ambulance service responded to about 12% of  Hout Bay area callouts, equating to 2187.16 hours of operational time spent on calls. This excludes standby time.

“There was an expected noticeable difference between response times for ambulances based in Hout Bay, and those from outside Hout Bay. Despite a decline in average call-out rate during the 2020 Level 5 lockdown, the volunteers were able to do more shifts and thus more calls in the community,” she said.

But researchers are concerned about the change in paramedic legislation in the past decade that disbanded short courses saying it poses a threat to the existence of the ambulance service and other volunteer services that rely on short course EMS practitioners to join the service.

Historically the short-course training programmes regularly produced recruits for the service with potential volunteers being able to study for as little as five weeks before volunteering.

“The majority of the volunteers have full-time employment external to emergency care, and this relatively low barrier to entry allowed them to become involved.

“Paramedics that hold a degree are more likely to be in full-time employment within emergency care and the longer training courses, the minimum being one year's full-time study, present a significant barrier to gaining new volunteers,” Cunningham said.

Since the change in paramedic legislation, Cunningham said there have been fewer new paramedics joining the service.

She said the effect of the discontinuation of short courses on the sustainability of volunteer organisations should be considered by policymakers and acknowledge the contributions made by such organisations.

“This could include strategies such as allowing students to work on volunteer services as part of clinical rotation, alternative and realistic training options, close integration with the full-time state EMS organisations and arrangements that are mutually beneficial for both while staying patient-focused.”

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